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          <h1 class="post-title" itemprop="name headline">《前牙瓷粘结性仿生修复》读书笔记9：第9章 维护与修补</h1>
        

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        <p>第9章 维护与修补<br>前牙粘结性瓷修复体固位较好，断裂率较小。5年成功率100%，10-15年成功率90%-93%。<br>粘结性瓷修复体的临床修复成功率与以下因素有关：①最大限度地保存牙釉质和牙本质，模拟天然牙生物力学结构；②最大限度地保护牙周组织。粘结性瓷修复体对牙周组织的影响极小，瓷贴面就位以后的菌斑指数和细菌量都有显著下降。<br>专业口腔卫生维护常规：<br>①有牙龈炎症时才需要，用手工器械洁治，方向与龈缘平行，避免采用根方-冠方的洁治方向，因为那样容易破坏边缘封闭或在粘结界面形成沟痕。禁止使用超声波洁治器，气动磨蚀抛光系统会损伤牙釉质瓷。任何时候都必须避免超声振荡尖与修复体表面的直接接触。<br>②抛光：边缘线的色素沉着可以用精细的硅橡胶尖轮或蘸有洁牙粉的声波刷去除，禁止使用粗的抛光膏，它会粗化瓷光洁的表面。<br>③应用氟化物：酸化磷酸盐氟化物凝胶（1.23%）绝对不能与瓷层接触，因为其会破坏瓷表面。局部涂氟多使用氟化钠凝胶（2%），它对瓷没有侵蚀性。<br>并发症及其处理：为患者制作硬质上颌牙合垫供其夜间戴用，以保护修复体，降低失败的风险。并发症包括粘结后瓷隐裂、碎裂、断裂、微渗漏。15年随访并发症发生率为7%。相关并发症的预后良好，口内喷砂机是最关键的器械。可以安全有效的在口内对瓷进行表面处理。<br>（一）碎裂<br>是指瓷自身的破裂，通常是由于突然的创伤力造成局部应力过于集中所致。切缘的微小碎裂在瓷粘结后随时都有可能发生，这与天然牙增龄性的釉质剥脱及其类似。<br>当表浅的小碎裂区没有影响到修复体表面的美观和功能时，可仅用超细的金刚砂抛光钻针和抛光砂对其进行抛光处理。当碎裂区较大时，先将瓷表面喷砂和甲硅烷化处理，再用复合树脂修补。（具体步骤略）<br>（二）断裂<br>原因：①树脂粘结剂残留在牙体上，表明脱粘结发生在树脂粘结剂－瓷界面。可能原因：不规范的粘结，如未将粘结剂涂布到酸蚀后的瓷表面；酸蚀界面被污染，如酸蚀后未用超声荡洗；或者没有正确使用甲硅烷偶联剂，如没有完全吹干。②树脂粘结剂残留在瓷修复体组织面，表明脱粘结发生在树脂粘结剂－牙体表面。这通常由于牙体粘结面是牙本质所致。在间接修复时，牙本质粘结方法的使用不当往往造成牙本质粘结失败。<br>（三）粘结后隐裂：迄今为止没有太好的办法，必须告诉患者瓷层的隐裂不会增加牙体隐裂的风险。瓷修复体隐裂可以在毫无征兆的情况下很早就出现，只有当患者因美观因素（隐裂纹严重染色）要求更换时才应该进行更换。<br><strong>(总结：一些问题的处理方法，还是做好前面的步骤，尽量预防吧。瓷贴面成功率蛮高的。）<br>全书读完了，做一个总结吧。<br>①瓷贴面修复的原则：主要就是生物性原则，即最大限度保留患者自身的牙体组织，并通过瓷贴面恢复患牙天然的外形和功能。<br>②前牙美学标准：主要考虑这几个方面：牙龈健康，邻接位置，牙龈顶点位置，牙龈缘位置，牙体长轴方向，牙齿外形，颜色，质地，以及颌曲线与微笑曲线的匹配等。我常常只注意牙齿本身和忽视了牙龈和咬合曲线，与面部协调性等方面。<br>③瓷贴面的适应症：主要分三类：改变牙齿外形、改变牙齿颜色、牙体缺损（外伤，发育缺陷等）。选择的时候，尽量先选择无创的，如漂白，树脂修复等。不行再考虑微创的瓷贴面。<br>④诊断：要注意医患交流和医技交流，诊断蜡型是一个很好的工具。<br>⑤牙体预备：尽量保留牙釉质，不要暴露牙本质。具体方法略了，等去学的时候实操吧。<br>⑥粘结：最好用光固化树脂粘结剂，不要用双固化粘结剂。做好修复体表面处理（HF和硅烷化）和牙体表面处理，粘结剂涂在患牙表面而不是修复体表面，缓慢就位，挤出多余粘固剂，沿修复体边缘清理粘固剂。要仔细调颌抛光。<br>⑦并发症处理：成功率蛮高的，预防问题更重要。<br>接下来就等着参加王老师的贴面班吧。</strong></p>
<p>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“好看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的CSDN博客地址：<a target="_blank" rel="noopener" href="https://blog.csdn.net/zwdnet">https://blog.csdn.net/zwdnet</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地</p>
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